Department of Internal Medicine and Transfusion Medicine, St. Agnes Hospital, Baltimore, MD, United States.
Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, United States.
J Crit Care. 2018 Feb;43:65-69. doi: 10.1016/j.jcrc.2017.08.033. Epub 2017 Aug 24.
Evidence suggests that trauma patients with hemorrhagic shock requiring massive transfusion have improved outcomes if resuscitated with a prescribed massive transfusion protocol (MTP). However, there is limited data regarding the efficacy of MTP in non-trauma patients.
This was a retrospective observational study of all patients who received a massive transfusion protocol for non-traumatic hemorrhagic shock over a four-year period. The primary outcome was in-patient hospital survival. We dichotomized recipients of MTP into survivors versus non-survivors, comparing outcomes of interest within the categories by nonparametric testing. Summary statistics expressed as median (interquartile range).
Fifty-nine patients were reviewed, with the median age of 59.0 (35.0-71.0) years old. Thirty-three (56%) patients survived. Survivors were younger, 57.0 (30.0-67.0) versus 64.0 (53.5-71.5) years old (p=0.047), and had lower Sequential Organ Failure Assessment scores (6.0 (3.0-8.0) versus11.5 (9.5-13.0); p=0.008). Patients on the medical service receiving MTP had an increased risk of mortality (odds ratio 4.26; p=0.02).
Over half of the patients receiving massive transfusion protocols for their non-trauma related hemorrhagic shock survived. Survivors were younger, were less acutely ill, and on non-medical services. Further research is needed to investigate best practice for transfusion in non-trauma related hemorrhagic shock.
有证据表明，接受大量输血的失血性休克创伤患者，如果使用规定的大量输血方案（MTP）进行复苏，其预后会得到改善。然而，关于非创伤患者 MTP 的疗效数据有限。
这是一项回顾性观察性研究，纳入了四年期间接受非创伤性失血性休克大量输血方案的所有患者。主要结局是住院患者的生存情况。我们将接受 MTP 的患者分为幸存者和非幸存者，通过非参数检验比较各分类中感兴趣的结局。汇总统计数据表示为中位数（四分位距）。
共回顾了 59 例患者，中位年龄为 59.0（35.0-71.0）岁。33 例（56%）患者存活。幸存者更年轻，57.0（30.0-67.0）岁 vs 64.0（53.5-71.5）岁（p=0.047），且序贯器官衰竭评估评分更低（6.0（3.0-8.0）vs 11.5（9.5-13.0）；p=0.008）。接受 MTP 的内科患者死亡风险增加（比值比 4.26；p=0.02）。
超过一半的非创伤相关失血性休克患者接受大量输血方案治疗后存活。幸存者更年轻，病情较轻，且不在内科。需要进一步研究以调查非创伤相关失血性休克输血的最佳实践。
